5238 - Laserfiche WebLink

Home Browse Search

APPLICATION FOR SANITATION PERMIT Permit No."07 --- -_„ -- (Complete in Duplicate) s „,,k Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thi plication is made in compliance with County Ordinance No. 549. 15 JOB ADDRESS A D LOCAT O _._ ---- - - - ,��// // Owner's Name X � -��_..1------- T� i / Phone Address------------------ A- --� O.e k ((�� ----------------•------------- ----------------------••------------------------- ----- �j Contractor's Name------------ --- 4F x�t _.- Phone- i=f pp`` -- - ----- ----- AIS_�?---l--p__q��__, Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other "j Number of living units: -------- Number of bedrooms ------ - Number of baths -- --__ Lot size -------"ZI_r�—t-,r�.a.:� Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tableft. Character of soil to a depth of 3 feet: San . Gravel E] Sandy Loam E] Clay Loam E] Clay ElAdobe Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s ewer is available within 200 feet.) Septic A: Distance from nearest well -/Oa----Distance from foundation----.64___--..Material- +_ No. of com artments--------- ) - " r1 - � p1 Size` I--x � .- ------Liquid depth---�Q -----------Ca acif L20- ----•-- r, Disposal Field: Distance from nearest well_"--.--_-----_"__Distance from foundationP y --------------------Distance to nearest lot line-__-.-------_•- � ❑ Number of lines-----------------------------------Length of each line-------•----------------------Width of french Type of filter material-------------------------Depth of filter material-----------------------Total length ----------- C� --------- ------------• ---••------------- Seepag Pit: Distance to nearest welt.--- pd-_�_-__-Distanc��jy f o fou dation---.. 4 �__.Dis#ante fio nearest lot line- vZQ --- Number Number of pits----__I------------Lining materialL._ .___�__'_ r-Size: Diameter----tea�_�'---__-Depth o2Q ' � � Cesspool: Distance from nearest well---_-__-_____.__Distance from foundation_ _______Lining material-------------------------------------❑ Size: Diameter------------------ ------------------Depth------------------------------ ------Liquid Capacity---------------------------- gals. y Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line--------------_----- _------___-.--__-___-._- ---------- Remodeling and/or repairing (describe):--------- ---------------------------------------------- --------•-----•---------------••-----•------------------------•-•-------------•--------------------------------------------•--------------•------------------- -----•--------•-----------••---------------------------------- -------------------------------------•----------- ------------------------------------------ -- ----- ----- - ----- -- -- ---- -- ---------------- ----- ------ - ------- - --- - - --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r (Signed) 01 --!--------- and/or Contractor) 1 eY: . .. (Title) --------------------------------------- --------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side), j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------- ----------------------- ---------------- - DATE ` REVIEWED BY----------------------------------- ---------- S- --- - ---- -------- BUILDING PERMIT ISSUED---------------------------- - ---------------------------------------------------------------- DATE---- ------------------------ - Alterations and/or recommendations:-- -._-.-_--._-----_-- -------------- - --- - FINAL INSPECTION BY---------------------- A�IAi ----- --------- Date-- --- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100